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This form must be submitted to HR Leave department prior to returning to work 2026
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How to use or fill out This form must be submitted to HR Leave department prior to returning to work
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- Click ‘Get Form’ to open it in the editor.
- Begin by filling out the EMPLOYEE INFORMATION section. Enter your last name, first name, middle initial, and employee ID. Specify your normal work week, shift times, division, department, title/position, and hours per day.
- Next, ensure that the PHYSICIAN'S STATEMENT is completed by your treating doctor. They will need to indicate whether you can return with or without restrictions and provide relevant dates.
- If there are any restrictions on your return to work, make sure these are clearly noted in the designated area. Your physician should also sign and date this section.
- Review all information for accuracy before submitting the form. Once complete, save your document within our platform for easy access.
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